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Bipolar disorders

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Bipolar disorders• Also considered mood disorders, include the occurrence of depressive episodes and one or more elated mood episodes• An elated mood can include a range of affect, from normal mood to hypomania to mania

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Bipolar disorders• In the most intense presentation, the person with bipolar disorder experiences altered thought processes, which can produce bizarre delusions.

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• Rating scale assessment tools: • Young Mania Rating Scale • Manic State Rating Scale• There appear to be no laboratory features that distinguish major depressive episodes found in major depressive disorder from those in bipolar I or bipolar II disorder.

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• Patients may receive treatment in acute inpatient psychiatric hospitals or in the community in an outpatient program • The decision about treatment setting is made according to severity of patients illness, including degree of mania or depression as well as risk of self- harm or harm to others.

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• Inpatient treatment is directed toward drug management as well as supportive psychotherapy in order to alleviate the acute manic symptoms.• Pharmacologic treatment for acute mania consists of the following: • Lithium (Lithobid) • Anticonvulsants, such as carbamazepine (Tegretol) and valproate (Depakene), for mood- stabilizing properties

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• Neuroleptic agents, such as risperidone (Risperdal), for acute psychotic thinking • Benzodiazepines, such as clonazepam (Klonopin) or lorazepam (Ativan), for acute agitation• Psychotherapy is used as described above in the section related to depression.

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• Psychiatric home care nursing to facilitate compliance with drugs and therapeutic interventions.• Community-based support group participation.

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DRUG ALERT• Patients taking lithium can develop toxicity related to elevated levels in the blood; therefore, lithium blood levels must be monitored periodically.• Initial therapy requires daily monitoring until a safe, therapeutic level is attained; weekly and then monthly monitoring is then recommended.• Lithium toxicity is related to decreased serum sodium levels and inadequate hydration.• Therefore, patients taking lithium must have normal sodium intake and drink at least 2 to 3 qt (2 to 3 L) of water daily.

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• Untreated bipolar disorder can lead to physical exhaustion.• Poor judgment and risk-taking behavior can lead to financial problems.• Alcohol and drug abuse problems can develop and cause disruption in the family.• Concurrent medical conditions may be exacerbated.